title: Early onset and high prevalence of gestational diabetes in PCOS and insulin resistant women before and after assisted reproduction.
abstract: OBJECTIVE
  Polycystic ovary syndrome (PCOS) and/or insulin resistance (IR) are frequent conditions in women choosing assisted reproduction techniques (ART). However, infertility work-up has to include testing of insulin sensitivity to diagnose IR. It was the aim of the study to analyze the frequency of impaired glucose tolerance (IGT) or gestational diabetes (GD) in the first weeks of gestation after ART in women receiving metformin.
  
  
  METHODS
  This study included 107 women who were seeking ART under the pretreatment of metformin for PCOS, confirmed IR, recurrent spontaneous miscarriages (RSA) or other fertility disorders. They were examined for prepregnancy health parameters (weight, glucose tolerance). When pregnancy was confirmed a 75 g oral glucose tolerance test (OGTT) was conducted between the 5(th) and 7(th) week of gestation.
  
  
  RESULTS
  A high rate of GD or IGT already was observed in the first weeks of pregnancy in our cohort under metformin treatment. The predominant risk factor for diagnosed early onset of IGT or GD (58 cases) was PCOS (p=0.014). The frequency of GD was the highest in the subgroup with prepregnancy confirmed IR not fulfilling the criteria of PCOS (55%); it was 40.6% in PCOS women and 26.1% in women neither exhibiting IR nor PCOS.
  
  
  CONCLUSIONS
  Women seeking ART and being treated with metformin still show a very high rate of GD or IGT after achieving pregnancy by ART. Therefore in women undergoing ART screening for GD should be performed as soon as pregnancy is confirmed to avoid miscarriages due to overlooked uncontrolled glucose metabolism.
authors.affiliation: Center for Reproductive Medicine, Regensburg, Germany. pdbalspratsch@t-online.de
authors.forename: M
authors.initials: M
authors.lastname: Bals-Pratsch
authors.forename: B
authors.initials: B
authors.lastname: Grosser
authors.forename: B
authors.initials: B
authors.lastname: Seifert
authors.forename: O
authors.initials: O
authors.lastname: Ortmann
authors.forename: C
authors.initials: C
authors.lastname: Seifarth
mesh_terms: D000328:Adult; D017668:Age of Onset; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007247:Infertility, Female / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D007333:Insulin Resistance / Q000502:physiology; D008687:Metformin / Q000008:administration & dosage; D008875:Middle Aged; D011085:Polycystic Ovary Syndrome / Q000453:epidemiology*; D011247:Pregnancy; D015995:Prevalence; D027724:Reproductive Techniques, Assisted; D013997:Time Factors; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin